Mentee Application
We are so glad you're interested in the F.A.M.I.L.E.E. Mentor Program! Please take a few minutes to fill out this survey so we can learn more about you and pair you with a mentor that will be a good fit. You will be contacted by the Rainbow Center Graduate Assistant, Julia Anderson, via email with more information about FAMILEE in the fall.

* The identity information questions are optional and an opportunity for you to share any preferences you may have in regards to your mentor/mentee pairing. For example, if it is important to you to be matched with someone with the same gender identity as you, please let us know.

Email address
Preferred first and last name?
Your answer
Pronouns
ze/hir ,he/him, she/her, they/them,
Your answer
UCONN Email Address
Your answer
Phone number
Your answer
Age
Your answer
Hometown
city,state, country if not from the United States
Your answer
Number of college semesters completed at UCONN
Your answer
Major & minor(s)
Your answer
How do you identify regarding race/ethnicity?
Your answer
How do you identify regarding religion or spirituality?
Your answer
How do you identify regarding gender identity/gender expression?
Your answer
How do you identify regarding sexual orientation?
lesbian, gay, questioning, straight, bisexual etc...
Your answer
What are you hoping to gain from your mentor?
Your answer
Rank your comfort level with being "out" regarding your sexuality and gender identity on campus
Listing a 1 here in no way prevents you from being a part of this program
Very uncomfortable
Very comfortable
How important is it for you to be "out" on campus, at work, or at home? Please explain.
Your answer
How would your friends describe you?
Your answer
Rank yourself on the following scale
Extremely Introverted
Extremely Extroverted
Please list some activities you have been involved with in high school or in college
Your answer
Do you have any specific requests for your mentor?
Your answer
Anything else you would like to share?
Your answer
Please complete the captcha before submitting the form.
Submit
Never submit passwords through Google Forms.
This form was created inside of University of Connecticut. Report Abuse - Terms of Service - Additional Terms